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tv   Discussion Focuses on Womens Health and the Zika Virus  CSPAN  August 4, 2016 12:00pm-1:01pm EDT

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and just after a couple of days it was closed because of these extraordinary times at the turkish -- for a couple of days. now it is fully operational. so questioning turkey's role in nato and others, because coalition is somehow far-fetched from my point of view and i can say that turkey has been a very important part of the alliance for the past 60 years hopefully our allies will stand with us against this coup attempt. gray, it's your turn. usual, they asked me to
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wrap things up. we are finished so i want to thank our distinguished panel for i think a superb outline of the challenges we face and certainly some good suggestions on what to do about it. i couldn't help but think -- it took us about 200 years of pre-colonial experience before we became a republic and ultimately a democracy. it takes a long time to really get to that point. 216 years ago, i guess, is when turkey as a nation started that climb, at the end of the ottoman empire. you had the big movements of what they call social reform. >> we will leave the tail end of
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this event to go live to a discussion on how the zika virus is affecting women's health care in the u.s. of to by the center for american progress just getting underway. >> in recent months, we have seen the zika transmission escalated in parts of the developing world and here in the united states. according to the centers for disease control and prevention, the mosquito-borne virus has infected over 6000 people in the and territories including more than 800 pregnant women. the pentagon has reported that at least 33 american servicemembers have contracted zika overseas. the floridaek, health authorities reported the first likely cases of mosquito transmission in the continental united states. as the cdc director recently declared, zika is now here. these cases are just the
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beginning and congress can no longer ignore this urgent and dangerous public health crisis. the center for american progress estimates that more than 2 million pregnant women in the united states are potentially at this summer virus and fall. for pigment women, the zika virus can cause and lead to a serious condition of birth known as microcephaly which can have severe and lifelong effects on children's physical and mental development. it can cost anywhere from 1,000,000-10,000,000 dollars over a lifespan to care for a child with microcephaly and there is no vaccine for the condition. nor is there one for the zika virus. oft is what makes prevention zika in the first place so critical. unexpected health issues like -- presentevent tremendous challenges for
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already disadvantaged communities and sink families deeper into poverty. this is a vicious cycle as many of these committees living conditions that can compound zika transmission including lack of access to shelter or air-conditioning, living or working near standing water, and inadequate health insurance coverage. these families cannot afford to wait any longer for congress to take action on zika. the good news is we can prevent zika transmission. we can response efforts, help ensure access to contraception, family planning, and maternal health care for .omen at risk for families of children born with microcephaly, we can ensure access to health care and support services and we can support research and development for a vaccine an adequate testing. in order to do all of this, we need congress to abandon
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political wrangling and allocate adequate emergency funding to combat zika. without harmful restrictions on women's health care. since president obama's request in february of $1.9 billion in emergency zika funding, congress has played political football with the lives of those at risk for zika transmission. in fact, the situation has become so dire that the administration has had to shift money from the fight against because congress won't approve new funding. senate majority leader mitch mcconnell, house appropriations chairman hal rogers, representative tom full and other republican leaders have before then politics needs of the people they were elected to serve. here we are in august, the day before the olympics in brazil, responsiblezika is for over 4600 microcephaly cases
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alone and we still have no resolution, no dedicated emergency funding. congress has gone vacation. even after they return, senator mcconnell and republican leaders have promised to make sure an actionll is as packed as ever. we cannot let that happen. the time for denial and delay has long past and every day without this funding puts more women and families at risk. make no mistake, we have the tools to fight zika. what we lack is a congress with the political courage to do right by the american people. from aou will hear distinct panel of public health experts and advocates who are fighting to ensure that women and families have access to the services they need in the face of zika. their discussion will examine our efforts to combat this crisis and why women's health
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care must be an integral part of -- effective the response. first we will hear from someone who has been at the front lines of the crisis, dr. jewell mullen deputy secretary for health at the department of health and human services, dr. mullen has helped coordinate the administration's response to zika at home and around the globe. hear herrilled to insights this afternoon. please join me in welcoming [applause] dr. mullen. [applause] >> good afternoon. i would like to thank mira and partntire cap team to be a of this important event i want to thank you for the introduction.
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i especially appreciate this convening because we are discussing an ever important topic, ensuring access to maternal and reproductive health , theat a critical time zika outbreak. the disease is characterized by transmission by both mosquitoes and sex that has associated potentially severe birth outcomes. speaking from my new, almost seven month or as a federal official, i want to share that as a physician and public health practitioner, i'm speaking to you from both of those positions knowing my words are those of a person will always be herself as a doctor first. people who only know me as someone who works in government, asked me, have you ever been a real doctor?
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the way inu, from which i approach my work, that i still am. to know that i mean it and understand when i say i really appreciate this meeting and your work, because what you do is so much closer to the people, the patience than the i am at this point in my career. patience than i am at this point in my career. so much of the work and progress of the past several years has been rooted in the belief passed down from generation to generation that we can continue to strive toward equity. and we can work together to level the playing field for all americans. our sons andll of daughters, our families, the opportunity to grow and thrive and succeed. it's at the heart of that. the progress is at the
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foundation of our country's values. health is the bedrock of forms that foundation. you don't have to look far to see the results of that incredible work of the past several years which now includes having more than 20 million more americans who for the first time have access to coverage for themselves and their families. that's work that has led to a in thean 50% decline uninsured rate for african americans and a 27% decline for latinos. no longer becan denied coverage for a pre-existing condition like childbirth. there is a lot more we have to do. sometimes when we think about african-american and latino neighbors who are less likely to have access to health coverage and access to care. mobilizelenges us to around that reality.
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while women have improved access, we still have work to do for women's health knowing that women's health is far more than reproductive health but that we cannot separate the two. progress on women's health is a comprehensive approach focusing on health and well-being for all women. daughters, sisters, grandmothers, and sisters. two months ago at the white house united states of women summit were women from all walks of life came together. they said by working today, we can change tomorrow. i was fortunate to moderate a panel on unplanned pregnancy. conversation, there were many reminders that i wanted to share briefly for today. in that conversation about unplanned pregnancy, we had to convey tohat what we
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women and sometimes i say women and teens because i don't want us to think about one population. we want to convey things in a way that addresses the needs and desires an understanding of the people we serve. that conversation we had was informed by panelists from new york city and sierra leone among others. the diversity with which we need to approach that work to achieve equity is key. i have been able to observe in the work we have been doing on to addresshat means maternal and reproductive health with equity in mind and because of the work i have done in puerto rico, to understand that when you are addressing these issues for populations in which the economic conditions can far outweigh the concerns about a
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for which four out of five people infected have no symptoms, the conversation requires true information and informed decision-making for an are needing to be informed by the insights that everyone at the panel will share. today. i want to stress that because one of the things i understand working at the federal level is that with all of our expertise guidance,e and policy that is what it is. it's work that we do on behalf of populations. what has to happen with that work is it has to be translated to be useful for the individual people who need to be able to make personal decisions for
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themselves. in this case, around reproductive health. muchw as a physician how that relies on shared decision making conversations with , whocians who understand have the information required to be able to help women make those decisions. some of the work we have done at haven response to zika been investing more than $300,000 in emergency funding to our title 10 programs in puerto rico to expand access to contraception. we have been doing training. this is to ensure that our work with partners is culturally and linguistically appropriate. and to ensure that our services really reach those in need them most.
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at the office of population affairs, they released a toolkit for providers for counseling women. we are also working with states, territories, tribes on steps they can take to prevent and respond to zika. work,ide that health care we are sharing advice on the best ways to control mosquitoes, working to improve diagnostic capacity and to keep the blood supply free of zika. we already mentioned vaccine development and improving diagnostic development. underneath all of that, what might be most important is the hard work that is done every day to improve our communications
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-- an especially important technical and human skill for everything else that needs to be done to equitably ensure access and enable women to make the decisions they need for themselves. we are working with a number of partners from women's access to effective contraception. as we do all of this, i also understand the limitations of our reach on the federal level which is why it's so important for us to continue to partner with you and to take your feedback so that we can continue to be better at our effort. but we do need to work with you to spread the word about zika, how it's transmitted, how pregnant women, women of childbearing age and actually everyone can protect themselves. advocacy forngoing our communities, for us to have
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the resources that we need to implement not just mosquito prevention efforts and contraception efforts but sustainable improvement in toditions which, in addition helping us address zika in the long run when we talk about disparities and equity, can make many more kinds of differences the lives of people along the way. thank you for your work. thank you to the panelists for what you do and i look forward to our ongoing partnership. [applause]
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>> thanks to both of you for setting the stage for this important conversation. i'm a senior fellow at the center for american progress. i will be moderating the panel discussion portion of today's program. we have an impressive group of women's health experts here on the panel today. i will introduce them briefly but also encourage you to access their full bios online. and thea beautiful redn dress, we havene marie benootez, senior director at the national latina institute for reproductive health. she was responsible for the organization's washington dc office and oversees all government relations and policy advocacy work. prior to joining the latina institute, she worked as public
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policy director for planned parenthood affiliates in california. clearcoleman, in her seventh year as president and ceo of the family planning and reproductive health association. she served as president and ceo of planned parenthood before that in new york. a number of positions in the united states house of representatives including chief of staff and legislative director for appropriations committee ranking member nita lowey. at the end, we have dr. christopherzahn who is vice president of practice activities for aycock. a retired air force officer, and member of the armed forces district, he received his uniformedgree from services university and is a specialist in comprehensive obstetrics and gynecology and has been practicing for 29 years.
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he served asg acah a physician and the department of obstetrics and gynecology and pathology at walter reed national military medical center. last but not least, we have letania. she is the executive director of planned parenthood global and vice president global. in this role, she sets the course for the international engagement on all international , prior to joining planned parenthood, she worked for the united nations children's fund as well as the u.s. agency for international development. thank you all again for being here. the first question i have this afternoon is directed to all of you. you all to describe how your organizations are working to address zika. let's start with claire. our association is a
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membership association in all 50 states and several territories. we represent nearly 800 institutional providers of family planning and sexual health care nationwide so that includes 30 three state governments, 15% of the nations federally qualified health centers and 80% of planned parenthood affiliates as well as many other private not-for-profit providers of family planning. we are working on zika response from two responses. the first is in service delivery. the federal advisory around how we should address peoples concerned, women and men in health services, has led to concern and confusion in the field about how to translate guidance which hasn't moved as new information has come to light to individual patients who come in with concerns. we have a team in texas today meeting with title 10 family and theirrantees
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service delivery network to talk about how to translate the guidance of coming from the feds and local health department into practice. how do you operationalize preparedness and what do providers and local communities need to know today in order to be appropriately responsive to the field? in advocacy and communications raising the voice and concerns of this network. we have about 4100 health center sites around the country in governmental units, private not-for-profit units which are working to interpret this guidance and operationalize it for their community and to community awareness and make sure they have supplies on hand. it's important for us to participate in the coalition effort to call attention both from the administration and the congress to the pressing need for resources. marie? we are the only latina
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national organization that represent 28 million latinos and their families. we do it through reproductive justice. --t we do is offer to fall community -- we have mobilization that works in teams in new york and florida, in texas and virginia which also happens to be the hotspots where zika is taking place. a lot of our work right now is working with the community and trying to answer questions and trying to hear what their concerns are and what their needs are. then relaying that backup to d.c. which of the second part of our work which is the advocacy and lifting those concerns and addressing them and putting pressure on congress, for example, to move forward with emergency funds. >> thank you. >> it's a pleasure to be here and thank you for having this conversation.
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us at planned for parenthood because we have the privilege of serving one out of five women in this country and over one million people per year in latin america and africa. for us, it's incredibly important to keep women at the center of this debate around zika. on a normal day, women who are in parts of the country whether its geographic or parts of the world where they are not receiving services, they have unmet needs we are trying to address on a normal day. in latin america in particular, the rate of the portion is startling. we were talking earlier this week with our colleagues in the government about the average ,5-year-old in latin america their initial sexual entrance was through violence or rape. start askingers why we just wait to get pregnant while we figure at how to handle zika, these are the women we are
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talking about. they cannot do that. that womenmportant remain at the center and we take the caution fromwho and cdc that reproduction has a -- has to be a huge part of the response amount for our work is centered. >> thanks very much for the opportunity to be here. over 50,000htly members of obstetrics and gynecology and this area is of special interest. time, it's airst unique time, it is the first time when there is a mosquito borne illness whose primary impact his birth defects never before seen. bes an incredible time to involved in women's health care. our major goal is primarily clinical.
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we are in daily contact with the cdc. to spread the message and information the cdc develops. these guidelines change quite frequently. our guidelines probably six times in the last couple of months. the most recent one came out last month -- last night to advise and not surprisingly, when there was little information known in the beginning, the guidelines were relatively brief. now there is more known but clearly, we know far less and the guidelines are much more expanded. they are challenging to understand and implement. the implementation pieces translating those guidelines into practice in the trenches. a patient shows up who has been exposed and they are traveling somewhere and what to do and how to get the testing done and how
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to interpret the testing and advise her on what her risks are and what the prognosis is as best we can and how to further manage the pregnancy. theork very closely with other women's health care organizations, nurse practitioners, midwives, family practice and anyone involved in women's health to try to get this message out as much as possible. involved in advocacy not only for the funding issue but also access to health care and reproductive rights, etc.. there are two populations, the women who are pregnant or planning to and their aspects and clearly, there is avoiding the pregnancy. freeden said we don't know how to prevent zika but we do know how to prevent pregnancy and we need to make an effort to do that. >> thank you. can you talk us through the standards of care in a zika related case for to attrition's
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for pregnant women particularly? should have made more copies but i have our most recent practices. for women generally, it varies based on whether the person lives in an endemic area versus has traveled there. lasttunately, as of the week or so, we now have an endemic area on the mainland. with the majority, there will be those people who travel to an infected area. there are guidelines as to who should be tested and what type of testing should be done. it has gotten a little bit easier with the most recent guidelines. there is a division between whether they have been exposed within the first two weeks or it has been after two weeks but before 12. there are guidelines as far as what type of testing should be done in the early exposure. --s a combination of mallya
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of molecular testing beds done on the blood and the urine specimen and, depending on the result of that, a follow on test looking for anti-bodies is done. they sort of flippant people exposed beyond two weeks. depending on the result is how they are managed. if the woman test negative and she is asymptomatic, we would generally recommend an ultrasound to make sure there are no abnormalities. if that is normal, they are cleared for the most part. positive,who test it's a more intensive surveillance looking for abnormalities. i can keep on going for three hours. aboutback to the issue what we know, we know that 80% of women who are exposed will not develop symptoms which makes it incredibly challenging. if aso don't know that woman gets infected, what her risk of transmission is.
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we don't know how many actual babies will be infected and the race that have been reported range from 1-30% which is huge. we don't know if there are certain women and 80's that might be at higher risk of getting infected compared to those who don't. the mighty underling immune profiles or other cofactors that may play a role into how that maps out. for the women who are asymptomatic but exposed, how they develop disease. the other is the time course. we used to think based on some of the initial data that women were at higher risk of having an infected fate as if they were exposed in the first trimester. there has been subsequent reports that refute that and andn can be exposed later that rep. tonko: were us will enable the fetus to develop abnormalities. we know from some basic science research that has been done that in a lot of infectious disease, the damage that occurs in
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whatever organ system it is can be related to these infections but also to the human -- to the immune response. we know from some data in zika that it can directly attack brain cells, the neurons in the brain. ae of the real fears and clear unknown is that even an infected woman with a normal baby that does not show symptoms, we don't know that that virus is not going to continue to attack the brain cells of the newborn after birth. what thoseidea developmental abnormalities may or may not be and what the risks are and what the percentage will be. of the most important aspects of everything we do is the registry the cdc has created to follow these children after birth to see what happens to them down the line. >> thank you for that. i want to shift things and talk about the title x family -- the title xm
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family planning program which claire talked about. title10tant as the program is for women, it's also been a big topic on the hill. of making in terms sure that women have access to family planning through title 10 clinics. can you talk more about how as far astitle 10 is family access for women? >> at first, i would love it to be more central. neither the president possibly in the request for emergency spending which came about two months before the cdc confirmed causality and all of the negotiations that have happened throughout the spring added additional sources for the planning network. was enacted in 1970 under richard nixon and is intended to provide a network of direct health services as well poor, low income,
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uninsured or underinsured people across the united states. network has about 4100 service sites in all 50 states and the territories and the city -- and d.c..four we see about formally and people. to put that in perspective, we estimate that about 20 million women of reproductive health agent meet funding in order to access the contraceptive supplies and services they need. we are meeting about 1/5 of the need in the title 10 network. must see patients without regard to their ability to pay. healthue all public service act programs. we must see people without regard to documentation or whether or not they can prove citizenship. these networks are providing
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direct contraceptive care, counseling, pregnancy testing fc,i screening and treatment as well as services that support people who want to become pregnant. we must equally support people who want to achieve pregnancy and that includes basic infertility screenings as well as provide services to help people prevent pregnancy. there is no question that this is the network that is the safety net for the united states. funded centers are not just a place for people with no insurance. insurance water outdoors everyday and folks with medicare walk through our doors every day. the funds subsidize the care for people who have no other pay soars. these are health centers as diverse as the one in dallas which operates outpatient women's health center at 33 state governments run their title 10 networks in mississippi, florida, alabama, north and south carolina as well as states like idaho, vermont.
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these are states where the title 10 money goes for the state government and they authorize the network. throughout these networks, people are being seen regardless of their ability to pay for it what we need is a drastic infusion of funds to be able to afford first the staffing necessary that is trained and ready to do a wide variety of contraceptive counseling and that's important for long acting reversible methods of contraception. actuallyhe funds to buy supplies and have them available same day on-site all across the country but particularly in the endemic areas. and we need funds to support the community actually buy supplies and have them available same day awareness and partnerships we are being asked to serve. we are being asked by the fed to programsith wic because that population is often one we see in title 10 to make
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sure that the people coming in for wic services can get an idea of what's available in title 10 but there's no funds to do community education or partnership development or awareness. the work has taken $41 million in cuts since 2010. it's a network that has lost enormous capacity, lost 1.1 million people out of the networks and close health centers and lost staff. i came from providing services and i did the rounds of layoffs in three years. you cannot bounce back when the crisis arrives unless you have the money to put the people into place that make these services possible. >> from what you said so brilliantly, title 10 has an important role in communities. it's already underfunded in terms of the need. aso when you think about
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public health concern like zika, you will have even more people in need of access to services through title 10 clinics so thank you so much for that. let me shift things to anne marie. i would love for you to talk about the potential impact that zika could have particularly on the latino community. it was something that dr. mullen touched on in her remarks particular how communities of alor could experience disproportionate impact when it come to zika so please talk about that. >> thank you very much. i will echo a lot of what has been said. clinics totitle 10 access care because we have a diverse community. roadblocks inof the ability to access care. certain things that are uniquely impacting our community are things like education.
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in my earlier remarks, i said we hear from people on the ground and one thing we hear constantly is that there is very little information right now going to the community. it is hot and cold. zika is really dangerous or zika's not going to impact me at all. there is some desire to learn more. been requests we know of from community health workers who have the ability to reach out to the community in a culturally competent way but they don't have the access to that training to learn more about the zika and what they can do. is calling the families in central america and trying to find out what they know so they know what to do here in the united states particularly in the endemic areas. there has been cuts to title 10
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clinics but we have not seen the aca fully realized. in states where we are focused in like florida and texas, medicaid expansion is not happen there and it's so important so folks can have access to care if the clinic is open. going on the impact on how there is limited access, limited education, and limited resources and that is impacting our community. we have a lot to do. >> thank you for that. you mentioned florida which has been in the media and in the news of a past couple of days, particularly for new cases of locally acquired transmission of zika from mosquitoes. the things i wanted to mention about florida is the fact that florida has not expanded medicaid leaving lots
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of people without access to health services they need. also, there are over 2 million women there who want access to contraception and contraceptive services that don't have it so there are issues outside these new cases around local transmission. it's the fact that access to family planning and contraception is limited for some women in florida. i want to shift things a little bit and talk about the international context a bit. as most of you know, the olympics are set to begin in rio tomorrow. conversationn some about whether or not it has been rio to travel to particularly with the impact of zika there. i wantlatani to talk a little abouta -- i want to talk tolatania and have her talk a little about the impact in brazil. >> i will pick up for many of
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our panelists were coming from. zika will highlight of public health gap. we can talk about that in our country and understand where they are and were marginalized women and women who don't have access to health facilities will land. from the about that aspect of a developing country, even a middle income country like result where there is a host of communities, even afroly women, caribbean women in brazil and other very special communities. country and countries around latin america, they don't have access on a normal day to family planning, information about zika, two doctors even. will be we know that necessary as we seek to address this issue. when we think about what women will need for zika and to deal with this, we know they will
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need more access to contraception, not less. we look at where the funding is andg, where the emphasis the communication around mosquitoes is going. that womenle worried in brazil and other countries in latin america are not going to be as prepared and ready for this. we have seen that i think. follow the trend will that if we are not able to operationalize this in those countries. from the prospective arab partners we work with in latin america, it has been clear that we have to -- from the perspective of our partners we work with in latin america, it is clear we have to do more, a lot more around education to communities. it's not just in the u.s. think about women who every day have to deal with the complexities of their lives, having to think about this and not sure and not receiving information, no targeted
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services or advocacy towards them and lots of leaders talking about the issue but not much otherg going toward it than for mosquitoes in research and most of that is coming from outside those countries. i think it's crucial for us to , again, women being the center of this. how do you get information and services out to these women? how do you increase their access especially with sexual hearmission where people it in the news but they are not quite sure what it means. giving people the information they need to see for themselves what they need. i think that has to be from trusted providers like planned parenthood in the u.s. but the hundreds of partners we support in latin america. these are the people that women go to anyway. we have to make sure they are provided with the resources to be able to continue to have that conversation with their clients and get that out into the
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community to the various community-based programs we run. >> that's an important point. another thing that sort of comes to mind when we talk about underserved communities is how do we get information to those communities. the latino community, there are people not getting information and is not being translated into spanish. how do we reach the hard-to-reach communities especially when we're sitting in our d.c. bubble talking about zika and what these communities need? a young woman in southeast d.c., what does she know about zika and how she can get information about transmission? the international perspective, we have to look to organizations already doing it on other issues. i think about africa and ebola and malaria and hiv aids program. there are many community-based organizations dealing with
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similar public health crises. we cannot act like they are not there and just say we need to go look at mosquitoes and a vaccine. we have to lift up those organizations. planned parenthood as many partners around the role that do this work every day in their communities. they are far-reaching communities outside the major cities of most of the countries in latin america. we have to support organizations who is there every day doing this work and have a particular role but they are getting less funding than ever before. we have to think about international family planning that is getting less money than ever before. it's here and we have to address this but we are not thinking about how to support and strengthen those structures and partners already in place and we need to do that. >> those are the experts in terms of figuring out how to reach out. >> that's who they trust. you said earlier that zika is highlights where
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we have gaps in care and caps off of access and gaps of services. we know what to do to prevent an unplanned pregnancy. we should dedicate those resources and build upon them instead of cutting them which is what we see happening. looking at the infrastructure, building on it and going back to what you have said which is there are many community-based organizations including us who are on the ground and are already trusted for people to turn to. we need the resources to give them the information. i think that is a key element to what we are doing. >>. you mentioned resources. we talked about the lack of moving forward on the terms of funding from congress. the request was made several months ago by the president,
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$1.9 billion, to exist -- to address as transmission in the u.s. and abroad. we are we do while waiting for congress to appropriate the funding we need? >> we cannot wait. some effort from administrative agencies to move money that was available. arrigo got $300,000 in emergency money in april. that money directly went from title 10 into the grantees and puerto rico. it's important to underwrite their efforts. the rate of unintended pregnancy and puerto rico is criminally high. women do not have access to methods at a much greater rate than we see in the mainland u.s. so $300,000 was a drop in the bucket. they were able to put that money right to use.
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there has been a lot of emphasis on training. it's not unimportant. that's getting the pipeline together. the notion is that there are many places my country especially in governmental health systems or the local health department is family planning on monday, infectious disease tuesday, the school localon wednesday, back, health apartment on thursday because the local health department is doing everything. these are not networks offering access to contraception. when you wind up in a crisis in a governmental family planning system, sometimes delay is we don't do family planning until next monday. the notion of trying to be ready every day for a patient to make him through the door says they have been traveling and are exposed and are worried or i will be traveling, we want to
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meet their needs immediately. that's what we have been doing without any extra money. i would love congress to stop the shell game over existing resources. there is no way we can fill the gap in public health in the u.s. without coming to a reckoning about how much we have destroyed the public health infrastructure in the united states3. it's not just family planning, it's also true for stds. we understand seek a is a sexually transmitted infection. andost 30% of the capacity a sexually transmitted disease system in this country due to funding cuts over the last six years. this is not a battle ready public health infrastructure. it's unfortunate that it takes a crisis to draw attention. past, this country has been able to pull it together in crises. this is a place where we have stopped dead in our not making progress in the face of a crisis. >> the other thing to highlight
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is is more than just having providers and supplies to provide contraception. that's based on the assumption that 100% of the women will want it. we have cultural aspects that we need to consider. highlight puerto rico, the unplanned pregnancy rate is incredibly high but some of that is cultural. they just don't believe in contraception and some of it is religious background. we face some of the same issues on the mainland u.s.. it's critical to get the importance of the education out that this is a public health crisis and contraception is not just a pregnancy prevention because of having sex. it's prevention because of this incredible illness that can affect the unborn or the fetus. -- from ourn piece perspective, we have to educate our providers to get the word out and talk to their patients and work on the local
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communities but we've got to educate the patient's best what the risk really is and try to address some of these cultural misperceptions about contraception and the dangers. we've got another battle to fight as well. also the notion of institutional racism in our society. one we talk about building trust, people who are in the community, whether they are an institution fighting health care are they are a community resource, this is a place where people go to trust. it's not going to be earned in a crisis. people are being experimented on in puerto rico when it comes to prevention. if we are not honest about that -- not honest about that, you don't go into that conversation saying we recognize there has to be a reckoning then engages no way we can
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patients appropriately to make the decisions based on the risk that is right for them and sensitive to their needs and respect their autonomy. >> to your point about education, think about women who think about these things on unwanted pregnancies. think about the ones that want pregnancies. this difficult to think that any woman would say i will take off for a year and when it's time for them to get pregnant and they want to have a baby. we have to get information and be able to provide services and medical facility for women who want to provide -- who want to have babies even in an endemic area with zika. we're just highlighting together that the public health infrastructure and the resources that go into this under zika have to be thought about seriously. there is no time for politics. it's something we need to do soon and it should have been done before. public health the
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trust, education, sex education is a huge component. also recognizing that not everybody has the ability to access care because there is a policy in place like undocumented individuals cannot purchase into obamacare. ity also cannot purchase along with the help of subsidies so they cannot have affordable health care. we have to look at all the components to make it battle ready. in terms of contraception and latinos, a lot of is not being able to get to a clinic. partiallyemented hb2 and those clinics shut down. to drive to a clinic as far away and you have to take time off of work if you have a job to be able to do it. access to contraception is a huge component of white latinos don't have the ability to access care. known is that 96% of latinos who are catholic say
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they use contraception. we need 2-d bunk the myth about our community about why or why not we're using contraception. that is part of building this public health infrastructure so we can respond to emergencies in a timely way like zika. we will definitely get to questions from the audience after this. talking about restrictions are policies that keep folks from accessing health services, a lot of the states, the cdc has estimated could see an uptick in zika related cases. those are states that have highly restrictive abortion laws. access to safe abortion should be a part of the full spectrum foreproductive health care women in the situation. with that said, we will pass things over to the audience for questions.
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the floor is open. ok? yes. go ahead. they are coming. is around the last point. it's about access to safe abortions particularly if zika cannot be diagnosed until the fourth month. states, access is only for the first trimester. would you comment on that and also the issue globally? about theuickly talk fight for safe abortion continues. havehappens here is we been talking about these issues for a long time so whether it is zika or some other kind of issue that a woman has to have when
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she makes these decisions with her doctor, it is very clear that we have to ensure that there is an availability of safe abortion for every woman and access to it and not her jumping through hurdles. it's especially true now. we can talk about texas which might be a good example. there is no clinics and you have zika and their suit will be a situation where it's endemic there as well. what does a woman do? i go back to what planned parenthood has had for a long places we have to be in where safe abortion is legal and provide access to the most marginalized women who cannot get it and overseas, i think it's the same thing. we probably have a bigger conversation because in many of those countries if not most, it's illegal to have an abortion period and it has to be something that's serious where
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the country allows it in certain circumstances of health and is zika one of those? then you get into a policy question which many our partners are starting to look at now. >> i would add that all of the state policies focusing and attacking abortion, what is happening is limiting the full spectrum of comprehensive reproductive health care would also impacting access to care. your closing down clinics like texas. florida has passed a bill which has not been implemented but it would defund planned parenthood. that is a huge concern. you see the triple impact and how it impacts people's ability to have full autonomy of their bodies and therefore cannot protect themselves when things like this happen. we see an onslaught of this. many of us are working on the theseont to fight
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state-level laws that are negatively impacting women's health care. >> hi there. i feel very concerned for the young women in texas and their access to abortions. physician, abortion is a medical procedure3 . between aagine psychiatrist and an obstetrician, if a woman's fetus if evidence- indicates microcephaly, and abortion would be medically necessary if not for the emotional health of the family, etc., do you follow?
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it's a difficult question. predicament.ult thank you for reading between -- >> i very much understand. as has been said, we certainly support as an organization as well as our providers for the full range of reproductive care that's available. that includes abortion. alsoof the challenge has been when a woman manifests these findings by ultrasound, it may be late in their pregnancy and there are clearly state laws that impact the upper limit when they can be done. that is a separate problem. your point, i don't think i would use the term medically necessary. the determination is it should be an option. there should be an informed and shared decision-making process between the patient and their provider. it's the patient that ultimately makes that decision.
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anyn't think there would be clinician that would say it's medically necessary you terminate this pregnancy for whatever reason. it could be a genetic abnormality or chromosomal or a congenital defect or even a and and severally, for example, uses that. we don't say they are going to die after they are born. there are women who choose to terminate. afterthe patient's choice a fully informed decision making process. in time for her to process that. >> we have time for one more question back here.

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